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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Serum amylase level was determined in 129 cases (225 episodes) of chronic respiratory failure at acute exacerbation and in 59 cases (62 episodes) of pneumonia without respiratory failure as control. Cases with accompanying diseases, such as acute pancreatitis, parotiditis, ileus and renal dysfunction, which were expected to develop hyperamylasemia were excluded. The 225 episodes were divided according to the causes of acute exacerbation into 4 groups: pneumonia, bronchitis, right heart failure without infection, and others (e. g. hemoptysis). Hyperamylasemia (greater than 400 S-U) was observed in groups of pneumonia (15/40 = 35.5%) and bronchitis (12/95 = 12.6%), respectively but not in those of right heart failure without infection (0/73 = 0%) and other causes (0/17 = 0%). As a result, hyperamylasemia was found only under conditions of inflammation of lung parenchyma and bronchi with acute exacerbation of respiratory failure. On the other hand no hyperamylasemia was observed in 62 episodes of pneumonia alone without respiratory failure. It was concluded that both respiratory tract infection and acute respiratory failure are necessary factors for development of hyperamylasemia originating from lung or bronchi.
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PMID:[Hyperamylasemia in acute exacerbation of patients with chronic respiratory failure]. 138 26

Extracorporeal membrane oxygenation (ECMO) is effective for newborns with pulmonary failure unresponsive to conventional therapy. However, ECMO for the older child and adult has been controversial and not widely utilized. Over 4 years, 24 patients (aged 4 months to 16 years; 11 boys, 13 girls) underwent venoarterial ECMO (duration, 7 to 19 days) for respiratory failure. The diagnoses were: viral pneumonia (7), hydrocarbon aspiration (6), sepsis with adult respiratory distress syndrome (ARDS) (2), bacterial pneumonitis (2), tracheal stenosis (1), bilateral pulmonary contusion (1), diaphragmatic hernia with ARDS (1), ketoacidosis with ARDS (1), pulmonary artery injection of hydrocarbon (1), drowning (1), and epiglottis with barotrauma (1). Pre-ECMO blood gas ranges (and means) were PO2 18 to 65 (46), and PCO2 47 to 112 (65). Nineteen patients received dopamine, dobutamine, or other inotrope for associated cardiac and/or renal failure. Cannulation for ECMO was through neck or groin vessels in 17, and sternotomy in 7. ECMO flow rates were 150 to 250 mL/kg/min, to maintain PO2 greater than 100 and PCO2 less than 40. Nine patients (41%) survived ECMO, with eight long-term survivors, (4 hydrocarbon aspiration or injection, 1 pulmonary contusion, 1 viral pneumonia, 1 ARDS, 1 barotrauma), three of whom have mild neurological deficit. All patients with sternotomy, and 8 of 15 with neck and/or groin cannulation, required 1 to 5 explorations for hemorrhage while on ECMO. All survivors had primarily pulmonary failure; patients with combinations of pulmonary, cardiac, and renal failure did not survive. ECMO can be life-saving in the child with isolated pulmonary failure, but its efficacy in patients with multiorgan failure is uncertain.
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PMID:Prolonged extracorporeal support for nonneonatal respiratory failure. 140 44

It has been established that respiratory failure in young children with destructive acute pneumonia was enhanced upon intravenous correction of homeostasis disturbances with daily physiological volume repletion. Combined enteral-parenteral correction of homeostasis disturbances was an alternative technique.
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PMID:[The effect of infusion therapy on the ventilation-gas exchange function of the lung during acute destructive pneumonia in young children]. 141 99

Severe acute respiratory failure of varying etiology may require the temporary use of artificial gas exchange devices. So far, extracorporeal membrane oxygenation and extracorporeal carbon dioxide removal have been used successfully for this purpose. A totally implantable intravascular oxygenator (IVOX) recently became available. The authors have used IVOX in three patients who presented with severe respiratory failure secondary to pneumonia (n = 2) and post-traumatic adult respiratory distress syndrome (n = 1). At the time of implantation, all patients had hypoxemia (PaO2 less than 60) despite a 100% inspired oxygen concentration and forced mechanical ventilation. The duration of IVOX therapy ranged from 12 to 71 hr. All patients initially showed improvement in arterial oxygenation, allowing for moderate reduction of ventilator therapy after several hours. In one patient the pulmonary status deteriorated further, and she died from multiple organ failure despite IVOX therapy. One patient could be stabilized but died from other causes. The third patient is a long-term survivor 18 months after IVOX therapy. Gas transfer capabilities of IVOX are limited when compared to extracorporeal membrane oxygenation, and this may restrict its clinical applicability in cases of severe adult respiratory distress syndrome. However, IVOX may be used successfully in selected patients with less severe respiratory failure.
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PMID:Intravascular oxygenation for advanced respiratory failure. 142 5

All 87 known cases of bacteraemia due to Streptococcus pyogenes (beta-haemolytic group A streptococci) occurring during the peak of a nationwide outbreak in Norway (population 4.2 million) between January and June 1988 were reviewed. Clinical features varied widely and appeared largely to be dependent on the patients' age. The case fatality rate ranged from 11% in the age group under 30 years to 44% in patients over 60 years. Clinical complications such as shock, severe renal or respiratory failure or serious local infection occurred particularly in 30-to 59-year old individuals. Shock was manifest in 32% of the patients and carried a 68% case fatality rate. Chronic heart disease in the elderly and pneumonia seemed to be associated with a fatal outcome. In the 25 patients (29%) who died the disease showed a fulminant course, 80% dying within 48 hours after admission. However, 56% of the patients had experienced symptoms for more than two days before admission, suggesting that early diagnosis and treatment might possibly have prevented the development of a serious disease. This study revealed a wide spectrum of clinical manifestations in bacteraemia cases in a unique epidemiological situation caused largely by a single serotype of Streptococcus pyogenes; 89% of the 27 preserved bacteraemia strains carried the M-1 antigen. The observations call attention to the ability of these organisms to cause fulminant clinical illness, indicating a probable increase in both invasiveness and toxicity of group A streptococci responsible for the epidemic.
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PMID:Spectrum of disease in bacteraemic patients during a Streptococcus pyogenes serotype M-1 epidemic in Norway in 1988. 142 12

We cared 2 patients with diffuse pulmonary lymphangiomyomatosis (LAM) through the perioperative period. LAM is a disease of uncertain origin and poor prognosis because of respiratory failure. Therefore, it is important to provide not only a good anesthetic care but also a good preoperative respiratory care. In the first case (a 35-yr-old woman), an open lung biopsy was performed after dyspnea and sputum had disappeared with preoperative medications of a bronchodilator and some antibiotics. In the second case (a 35-yr-old woman), oophorectomy was performed after FEV1.0% had remarkably increased with preoperative medication of a bronchodilator. Both patients did well through the perioperative period without any trouble or complications, such as pneumonia or severe hypoxemia, presumably owing to our perioperative management system.
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PMID:[Two cases of diffuse pulmonary lymphangiomyomatosis]. 143 86

The clinical features of 22 postoperative multiple organ failure (MOF) patients, comprised of 8 with arterial disease (A-MOF) and 14 with gastrointestinal cancer (G-MOF), were investigated. Differences in the operative time, blood loss, and mortality were not significant. The initial organ impaired was the lungs in 78.6% of G-MOF patients and the heart or kidneys in all A-MOF patients. Infection developed in over 80% of both groups. In many A-MOF patients, the pneumonia or septicemia developed secondary to organ failure, while intraabdominal infection triggered respiratory failure in many G-MOF patients. Our organisms in infected specimens and their antibiotic sensitivities was valuable for the early administration of effective antibiotics. Upper gastrointestinal tract bleeding was important in the prognosis of both groups and occurred more frequently in A-MOF than in G-MOF patients. Consumption coagulopathy in A-MOF patients and DIC induced by infection in G-MOF patients mainly caused such bleeding. Preoperative administration of heparin was effective in improving coagulopathy. Furthermore, measurement of intramural pH with tonometer in the stomach and gastric irrigation with oxygenated perfluorochemicals were effective in the prediction and prevention of gastrointestinal bleeding.
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PMID:[The comparison of postoperative multiple organ failure with arterial disease to that with gastrointestinal cancer]. 143 3

4 cases of Pneumocystis carinii pneumonia in HIV-infected patients studied at the University of Zambia Medical School, Lusaka, were verified by bronchoalveolar lavage. Pneumocystis is common in North American AIDS patients, but has been considered rare in Africa. One reason may be that facilities for diagnosis, bronchoscopy with bronchoalveolar lavage, are not usually available. 44 consecutive HIV seropositive patients who were unresponsive to a 10-day course of antibiotics, and whose sputum was negative for acid fast bacteria, underwent bronchoalveolar lavage from February 1990 to December 1990. HIV status was assayed with Welcozyme ELISA kits, and P. carinii was detected with toluidine blue O stain. The 1st case of confirmed P. carinii pneumonia was a 35-year old man who had a productive cough for 4 weeks, fever, and dyspnea. He was treated with co-trimoxazole and was symptom-free in 3 weeks, but developed severe Stevens-Johnson reaction. His cultures were positive for M. tuberculosis at week 8. He was lost to follow-up. The 2nd case was a 26-year old man with a 6-month history of cough and white sputum, treated without effect with antituberculous medication. He improved over 3 weeks with co-trimoxazole, but died of respiratory failure 2 months later. The 3rd case was a 30-year old woman being treated for pulmonary tuberculosis, who became progressively dyspneic 7 months later. She developed a generalized maculo-papular rash after taking co-trimoxazole, so was given dapsone 100 mg/day, prednisone 1 mg/kg/day, and trimethoprim 15 mg/kg for 1 week. She improve in 3 weeks. The 4th case was a 30-year old man with a 4-week history of dry cough and dyspnea and recent high fever. He was given co-trimoxazole, but developed generalized purpura after 5 days. His treatment was changed to Dapsone 100 mg/day, prednisone 1 mg/kg/day, and antituberculous medication. He improved after 3 weeks, and is being maintained on Fansidar 1 tablet/week. These cases are remarkable because 2 of them also had pulmonary tuberculosis, which is often the presumed diagnosis of pneumonia in African AIDS patients. Furthermore, 3 developed serious drug reactions to co-trimoxazole, also considered an uncommon occurrence.
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PMID:Pneumocystis carinii as a cause of pneumonia in HIV-infected patients in Lusaka, Zambia. 144 Aug 16

Over the last three years six patients diagnosed of bronchiolitis obliterans with organizing pneumonia were studied. Diagnosis was established by open lung biopsy in 4 and by transbronchial lung biopsy in 2. The initiation of the symptoms was subacute although one patient evolved to respiratory failure requiring mechanical ventilation. The mean age of presentation was 68 years with male predominance over females of 5:1. The most frequent symptoms were fever and general malaise in 6 patients, cough and dyspnea in 4, respectively and weight loss in 2 patients. Functional respiratory tests showed restrictive ventilation disturbances in 4 out of 5 patients, mixed in 1 and a reduction in diffusion capacity in the 5 patients in whom it was determined. The radiologic pattern of multifocal alveolar infiltration was present in 6 cases. Interstitial involvement was also associated in 3 patients with pleural effusion in 2. Histologic findings of intraluminal polypoid masses affecting the bronchiols and alveolar conducts (bronchiolitis obliterants) with extension to the alveoli forming conjunctive Masson polyps (organizing pneumonia) was found in the 4 patients who underwent open lung biopsy and in 1 diagnosed by transbronchial biopsy although there were quantitative differences in the degree of alveolar involvement. Response to treatment with steroids was favorable in 5 out of 6 patients while the remaining patients spontaneously improved following thoracotomy.
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PMID:[Bronchiolitis obliterans associated with organizing pneumonia. Clinico-pathological study of 6 cases]. 144 38

17 cases with bronchial carcinoid were reported. 16 cases of them were proved pathologically after pulmonary resection, and the remaining one was confirmed histopathologically through bronchoscopic biopsy. 64.7% was under 40 years of age. The main clinical manifestations were cough, hemoptysis, fever and repeated pneumonitis. In one patient, the carcinoid was associated with Cushing's syndrome. Chest roentgenograms showed lesions centrally located in 12 cases, and peripherally located in 5 cases. Histological examination revealed 15 typical and 2 atypical carcinoid tumors. This disease was usually misdiagnosed as lung cancer, tuberculoma and benign tumors. Chest X-ray examination and fiberoptic bronchoscopic biopsy are helpful to the diagnosis of the disease. Pulmonary resection was performed in 16 cases. Two patients had hilar lymph node metastases, one of them had also involvement of pericardium. There was no operative mortality. In the follow-up study, the disease-free actuarial survival following pulmonary resection was 92.9% at 5 years. 2 patients died. One died of respiratory failure 4 months after pneumonectomy, the other died of pericardium involvement of carcinoid 8 months after operation. Resection is the only effective treatment for bronchial carcinoid.
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PMID:[Bronchial carcinoid. A clinical, roentgenological and pathological study of 17 cases]. 147 26


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